Reporting Workflow Revision - Brief Proposal

1. Proposed Workitem: Reporting Workflow Update

• Proposal Editor: Kevin O'Donnell
• Editor: Kevin O'Donnell?
• Domain: Radiology (& Cardiology?)

2. The Problem

Reporting workflow is getting more distributed; data collection, processing & reporting are more commonly spread across multiple locations, even multiple organizations.

Reporting workflow is getting more complex; need to coordinate/collate more inputs such as clinical processing, 3D reconstruction, and more combinations and permutations.

The original Reporting Workflow Profile tried to address earlier versions of this problem, but did so using the cumbersome (soon to be retired) GP-Worklist.

Costs from manual workflow likely include slower turnaround (a key metric for radiology), extra manpower for the manual tasks, lost/dropped actions, poor resource balancing, missing data, poor coordination, poor collection of performance metrics, poor tracability, etc.

Proprietary workflows sometimes address some of the above, but at a cost in flexibility and limiting choice/ability to use preferred systems.

3. Key Use Case

<<Revise to discuss the "ready to read" challenges, etc.>>

An imaging procedure is ordered which should be followed by running a clinical analysis package on the images, performing a CAD analysis and generating a 3D visualization. All four datasets should be considered in the interpretation and report.

• the three post-processing steps are performed by different people on different workstations
• there is more than one protocol that could be run in each step and they need to know which
• the techs need to know when the input data is available for them to start their work
• they should not have to go manually retrieve their inputs
• the output data should be identified and made available to the next step
• the radiologist may not know whether to expect all 4 of the datasets or only some of them
• the radiologist does not know when each is complete or when the data is available
• when there is a failure, there should be enough information for a management system to be alerted/intervene
• there should be information in the audit trails to give some idea of how the department is performing and where the bottlenecks, if any, are

Among other things, we would like to be able to:

• request reading or consultation by another facility
• provide references and access paths for images to read, images for priors
• precisely describe the requested action
• possibly indicate who you would like to do it
• provide avenue for requester to monitor progress and get pointers to results

4. Standards & Systems

Systems include RIS, PACS, modalities, post-processing, reporting, HIS, EMR

Standards include DICOM Unified Procedure Step

5. Discussion

This is basically about updating the existing Reporting Profile to be easier to implement and use, in part through using UPS.

UPS Status

• Radiotherapy implemented Sup 74 based on Sup 96 and successfully tested at two Connectathons
• now Final Text
• was used for PAWF

UPS Benefits

• retains many of the attributes used in GP-WL for easier transition
• much simpler object management logic
• supports push workflow, pull workflow, self-scheduling, etc.
• provides a subscription model for monitoring procedure steps
• improves referencing of input/output data, handling local network, media or XDS retrieval

SIIM TRIP

• SIIM is working on mapping/modeling radiology workflow steps and patterns (first draft completed)
• good potential for collaboration on defining needs, designing solutions and promoting the result

IHE Reporting Whitepaper

• Several years ago we did a whitepaper on reporting workflow which partly mapped it out and arrived at some conclusions. That material should be useful to this activity as well.
• The whitepaper stalled due to lack of participation from reporting vendors. That is a risk for this work as well. SIIM TRIP collaboration may help generate critical mass.

Questions:

• Should loosen the linkage to SINR as the output.
• Is this a clean compliment to the Reporting Templates?
  • Dovetail fairly easily. Don't have to be joined at the hip.
• Should we address MWL?
  • (While UPS would work, shouldn't mandate replacing MWL, but a useful compliment - perhaps add as an option to SWF)

Risks:

• we should confirm the need/business case does exist for these profiles. They may not have failed due to technical issues.
  • Feeling is that the business case is sound. There is a need.
  • Were there other inhibitors than the complexity of the GP implementation
  • Did people implement GPWL and balk at using SR for the output?

• we should be careful not to stray into trying to design universal workflow management. Even while limiting to Radiology, we should still be aware of general solutions (e.g. BPEL, etc).
  • do we need a RESTful interface to the UPS Service?
• Given that it is DICOM-based, how do we keep the EMR in the loop?

<This is the brief proposal. Try to keep it to 1 or at most 2 pages>